Biomedical subjects

Sepehr Shakib

Publications and source records attributed to Sepehr Shakib.

9 recordsLinked to original sources

PubMed2003

The Australian Centre for Evidence-based Clinical Practice generic audit tool: Auditmaker for health professionals.

Audit is an important step in the process of health care evaluation and quality improvement. Some of the barriers to audit include the lack of support in initiating an audit, difficulty with data collection and lack of time. Auditmaker is a computer package that guides the clinician through the initial process of designing an audit, choosing factors and outcomes to analyse, then provides customizable data entry forms, and finally simple reports summarizing the data. It has user-friendly features, such as help buttons, drop-down lists and built in comorbidities and outcomes of common interest. It provides a generic tool for performing an audit as well as providing an opportunity for different clinicians in different institutions or practice settings to perform similar audits using the same data collection tool, which can provide the basis of benchmarking. Auditmaker is available for downloading from the ACEPBCP website: http://www.acebcp.org.au.

Australia↗

PubMed2003

Diagnosis and therapeutic goals. What are you actually treating?

BACKGROUND: Bad prescribing frequently involves writing a prescription for a symptom or a diagnosis and not considering the other steps in the prescribing process. OBJECTIVE: To illustrate the process of therapeutic goals. DISCUSSION: Therapeutic goals are the answer to the patient's question: 'Why am I taking this medication?' Taking this step in the prescribing process allows for a greater consideration of available treatment options, greater individualisation of therapy, avoids treatment on the basis of surrogate endopoints, and may result in greater patient concordance.

Adult↗

PubMed2003

Therapeutic approach: how to get there.

BACKGROUND: After determining the therapeutic goals for an individual patient, the next step in good prescribing is planning a therapeutic approach to achieve these goals. OBJECTIVE: This article aims to illustrate the process of the therapeutic approach. An example of a patient with asthma is discussed, and the evidence base for the possible lifestyle interventions is reviewed. DISCUSSION: Clinicians often treat the therapeutic approach as a two step process of identifying nonpharmacological then drug related interventions. However, the scope of therapeutic approaches is really much broader than this. It encompasses lifestyle change, education, avoidance of triggers, procedural interventions, patient self management, as well as drug treatment. The latter may actually include medication cessation.

Adult↗

PubMed2003

Which drug class and why?

BACKGROUND: Having made the diagnosis, decided on therapeutic goals and the therapeutic approach, the next step is choice of drug class. OBJECTIVE: This article discusses the four factors to be considered when choosing an appropriate drug class: efficacy, safety, suitability and cost. DISCUSSION: The first consideration in choosing a drug class is the relative efficacy compared with other agents for the particular therapeutic goal. Safety is a broad issue involving adverse reactions, toxicity, tolerance and dependence, teratogenicity, and consideration of special at risk populations. Suitability involves consideration of contraindications to the medication as well as other factors such as the requirements for monitoring, drug formulation and the number of daily doses. Cost includes consideration of drug acquisition as well as the total cost of therapy, including by whom the cost is borne.

Humans↗

PubMed2003

Choosing a drug from within a class.

BACKGROUND: Having decided on a drug class, an individual drug needs to be chosen. OBJECTIVE: This article discusses the same four factors used in deciding the generic drug within a class as well as between different drug classes: efficacy, safety, suitability, and cost. DISCUSSION: The example of hypertension will be used to illustrate the choice of individual drugs within beta blockers and calcium channel blockers. Although a large number of options exist within each class, by considering the above factors, the choice is narrowed to only 1-2 preferred options. These drugs should then be added to the P- or Personal-drug list. By only prescribing agents on the P-drug list, the prescriber will become more familiar with their closing, adverse effects, and interactions, resulting in improved patient outcomes. Also when a new drug becomes available, it clearly needs to be better for the patient in terms of these factors, before it is added to the P-drug list.

Adrenergic beta-Antagonists↗

PubMed2003

Individualising therapy. The right dose, dosage form, frequency and duration.

BACKGROUND: Having chosen which drug to prescribe, the prescription now needs to be individualised for the patient in front of you. OBJECTIVE: This article discusses the factors that have to be considered when individualising drug therapy for each patient. DISCUSSION: Before considering writing a prescription it is important to develop a personalised approach for the individual patient. The prescription should also then be individualised as to the route of administration, dosage, dosage form, frequency, and duration of the medication being prescribed.

Aged↗

PubMed2003

Check suitability, minimise sue-ability!

BACKGROUND: Having chosen which drug to prescribe, the suitability of the medication needs to be checked before the prescription is written. OBJECTIVE: This article discusses what checking for suitability means and how it differs from specific considerations that a patient may have. DISCUSSION: A drug is unsuitable for a patient if it is very likely to cause a predictable adverse reaction, and its prescription, in the absence of extenuating circumstances, would be difficult to defend. A simple example is anaphylaxis to penicillins. It is important to distinguish between patients for whom certain drug therapy is unsuitable, and others who have specific considerations, where the drugs can still be prescribed, but where additional steps need to be undertaken either in prescribing or monitoring. Examples of each of these will be discussed.

Adrenergic beta-Antagonists↗

PubMed2002

Problems of polypharmacy.

BACKGROUND: Polypharmacy is common in the management of many conditions. The aim of good prescribing should be to avoid unnecessary polypharmacy. OBJECTIVE: To describe how the World Health Organisation Guide to good prescribing provides a structure for improving prescribing and avoiding polypharmacy. DISCUSSION: Therapeutic goals should be individualized in order to use only those medicines that achieve desirable outcomes for the individual patient. Nonpharmacological approaches should be reviewed as these can result in better patient outcomes and can reduce the dose and the number of medications used. Patients should be monitored for not only the effects but also the adverse effects of prescribed medications. If an adverse reaction is found, the therapeutic approach should be reassessed and alternative approaches or medications triald rather than adding another medication to ameliorate the adverse effects of the first.

Cardiovascular Diseases↗

PubMedDate not supplied

Prescribing: what's all the fuss?

BACKGROUND: Prescribing is a commonly used skill which has until recently been poorly taught in medical school curricula. This is despite the fact that there are a number of proven approaches to teaching better prescribing. OBJECTIVE: The WHO Guide to Good Prescribing is discussed, with an example elaborating the steps involved in the process. DISCUSSION: Central to this approach is the development of a rational and evidence based list of P- or personal drugs which the prescriber develops familiarity with and uses regularly for specific indications.

Drug Prescriptions↗